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General NPI Number Information
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NPI Number | 1124530449
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Entity Type | Individual
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Provider Name | JENNIFER SAMPSON MSN, RN, FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 10/26/2017
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Last Update Date | 03/29/2024
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Provider Practice Location Address
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Address Line | 601 BRIDGE ST
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City | EAST JORDAN
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State | MI
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Zip | 49727-9383
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Country | US
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Telephone | 231-536-2206
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Fax |
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Provider Business Mailing Address
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Address Line | 1594 SEELEY RD NW
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City | RAPID CITY
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State | MI
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Zip | 49676-9535
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Country | US
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Telephone | 989-573-1188
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 4704302893
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License Number State | MI
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